The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Oct 2004
Multicenter StudyPredicting the outcome of total knee arthroplasty.
The relief of pain and the restoration of functional activities are the main outcomes of primary total knee arthroplasty for the treatment of osteoarthritis. This paper examines the preoperative predictors of pain and functional outcome at one and two years following total knee arthroplasty. ⋯ Patients who have marked functional limitation, severe pain, low mental health score, and other comorbid conditions before total knee arthroplasty are more likely to have a worse outcome at one year and two years postoperatively. After adjusting for these predictors, it was found that patients from the United Kingdom had significantly worse functional outcomes but similar pain relief compared with those from the United States and Australia.
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J Bone Joint Surg Am · Aug 2004
Multicenter Study Comparative StudyFunctional outcomes following trauma-related lower-extremity amputation.
The principal aims of this study were to examine functional outcomes following trauma-related lower-extremity amputation and to compare outcomes according to the amputation levels. We hypothesized that above-the-knee amputations would result in less favorable outcomes than would through-the-knee or below-the-knee amputations. A secondary aim was to examine the factors, in addition to amputation level, that influence outcome, including the type of soft-tissue coverage, selected patient characteristics, and the technological sophistication of the prosthetic device. ⋯ Severe disability accompanies above-the-ankle lower-extremity amputation following trauma, regardless of the level of amputation. Clinicians should critically evaluate the need for a through-the-knee amputation in patients with a traumatic injury. The results of this study also underscore the need for controlled studies that examine the relationship between the type and fit of prosthetic devices and functional outcomes.
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J Bone Joint Surg Am · Jan 2004
Multicenter Study Comparative StudyMinimally invasive total knee arthroplasty.
Currently, minimally invasive total knee arthroplasty is defined as an incision length of < 14 cm. However, the length of the incision is not the primary influence on potential postoperative benefits to the patient and should not be the only characteristic of the minimally invasive approach for knee arthroplasty. Some other factors that should also be included in this definition are: 1. ⋯ Extensive open exposure, prolonged patellar eversion, and dislocation of the tibiofemoral joint should evolve into a vastus medialis muscle split with patellar subluxation, retraction but not dislocation of the patella, and avoidance of gross dislocation of the tibiofemoral joint. Developing the techniques of minimally invasive total knee arthroplasty may be difficult and time-consuming, but patient benefits and satisfaction should outweigh the extra effort required. These changes require well-designed clinical studies to further document their effectiveness.
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J Bone Joint Surg Am · May 2003
Multicenter StudyFoot and ankle fractures in elderly white women. Incidence and risk factors.
Although foot and ankle fractures are among the most common nonspinal fractures occurring in older women, little is known about their epidemiology. This study was designed to determine the incidence of and risk factors for foot and ankle fractures in a cohort of 9704 elderly, nonblack women enrolled in the multicenter Study of Osteoporotic Fractures. ⋯ Overall, foot fractures appeared to be typical osteoporotic fractures, whereas ankle fractures occurred in younger women with a relatively high body mass index.
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J Bone Joint Surg Am · May 2003
Multicenter StudyGradual femoral lengthening with the Albizzia intramedullary nail.
Gradual limb lengthening with currently used external fixation techniques can result in less than optimal outcomes, with complications including infection, stiffness of adjacent joints, and secondary axial deviation of the extremity. We describe a totally implantable lengthening device designed to provide results similar to those achieved with external fixation devices, with fewer complications and improved outcomes. ⋯ Femoral lengthening with use of the minimally invasive Albizzia technique provides a reasonable alternative to external fixation that is well tolerated by patients and results in excellent function with little or no distortion of body image.